Preface to the First Edition



The publication of the Guide to Clinical Preventive Services marks the beginning of an important

new phase in the battle against premature death and disability. Abundant evidence documents that

the majority of deaths among Americans below age 65 are preventable, many through

interventions best provided in a clinician's office. The means are available to prevent many of

these premature deaths, as well as many injuries and other types of morbidity. This Guide,

resulting from the most comprehensive evaluation and synthesis of preventive interventions to

date, offers an operational blueprint for their delivery.



Prepared under the supervision of the U.S. Preventive Services Task Force, with staff support

from the U.S. Department of Health and Human Services, the Guide rigorously reviews evidence for

over 100 interventions to prevent 60 different illnesses and conditions. The problems addressed

in this report are common ones seen every day by primary care providers: cardiovascular and

infectious diseases, cancers, injuries (both intentional and unintentional), alcohol and other drug

abuse, and many others. Primary care clinicians have a key role in screening for many of these

problems and immunizing against others. Of equal importance, however, is the clinician's role in

counseling patients to change unhealthful behaviors related to diet, smoking, exercise, injuries,

and sexually transmitted diseases.



The Guide is the culmination of over four years of literature review, debate, and synthesis of

critical comments from expert reviewers. It offers the Task Force members' best judgment, based

on the evidence, of the clinical preventive services that prudent clinicians should provide their

patients in the course of routine clinical care. The recommendations are grouped by age, sex, and

other risk factors. The quality of the evidence supporting each recommendation as well as the

recommendations of other authorities are listed wherever possible, so that the reader may judge

for him- or herself whether specific recommendations are appropriate.



Some will offer criticism that the recommendations go too far, expecting busy physicians and

nurses to abandon their other clinical duties to become counselors or nutritionists. It is our belief

that the "new morbidity" of injuries, infections, and chronic diseases demands a new paradigm for

prevention in primary care_one that includes counseling about safety belt use and diet as well as

giving immunizations and screening for cancer.



Others will find the Task Force recommendations too conservative. By limiting recommendations to

those screening interventions, counseling maneuvers, and immunizations that have proven

efficacy and effectiveness, the Task Force reaffirms the commitment to first, do no harm. All

possible preventive interventions have not been examined, of course; much remains to be done as

research yields new data on efficacy and effectiveness.



The Guide has benefitted from unprecedented cooperation between the U.S. and Canadian Task

Forces, between the Federal government and the private sector, and between the Task Force and

literally hundreds of reviewers. This in itself is a gratifying accomplishment. But the real

challenge lies ahead, in the offices and clinics of busy practitioners. It is our hope that the solid

scientific base provided by the Guide will facilitate efforts to meet that challenge to improve the

health of the American people through the delivery of effective services for disease prevention and

health promotion.

ROBERT S. LAWRENCE, M.D.	                                         J. MICHAEL McGINNIS, M.D.

Chairman, U.S. Preventive 	                                         Deputy Assistant Secretary for Health and

Services Task Force	                                                     Director, Office of Disease Prevention

Chief of Medicine, Cambridge Hospital	                  and Health Promotion

Director, Division of Primary Care	                            U.S. Department of Health

Harvard Medical School	                                         and Human Services

Cambridge, MA	                                                    Washington, DC



April 1989